Background: With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative D-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography...Background: With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative D-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography. Objective: To evaluate and compare the safety of 2 diagnostic strategies for deep venous thrombosis. Design: Randomized, multicenter trial. Setting: Four university hospitals. Patients: 810 outpatients with suspected deep venous thrombosis and negative results on proximal vein ultrasonography. Interventions: Erythrocyte agglutination D-dimer testing followed by no further testing if the result was negative and venography if the result was positive(experimental) or ultrasonography repeated after 1 week in all patients(control). Measurements: Symptomatic deep venous thrombosis diagnosed initially and symptomatic venous thromboembolism during 6 months of follow-up. Results: Nineteen of 408 patients(4.7%) in the D-dimer group and 3 of 402 patients(0.7%)in the repeated ultrasonography group initially received a diagnosis of deep venous thrombosis(P< 0.001). During follow-up of patients without a diagnosis of deep venous thrombosis on initial testing, 8 patients(2.1% 95%CI, 0.9%to 4.0% ) in the D-dimer group and 5 patients(1.3% CI, 0.4%to 2.9% ) in the repeated ultrasonography group developed symptomatic venous thromboembolism(difference, 0.8 percentage point CI,-1.1 to 2.9 percentage points ; P >0.2). Venous thromboembolism occurred in 1.0%(CI, 0.2%to 2.8%) of those with a negative D-dimer result. Limitations: Seventy patients(8.6%) deviated from the diagnostic protocols, and 9 patients(1.1%) had inadequate follow-up. Conclusion: In outpatients with suspected deep venous thrombosis who initially had normal results on ultrasonography of the proximal veins, a strategy based on D-dimer testing followed by no further testing if the result was negative and venography if the result was positive had acceptable safety and did not differ from the safety of a strategy based on withholding anticoagulant therapy and routinely repeating ultrasonography after 1 week.展开更多
目的:探讨下肢闭合骨折术前并发深静脉血栓(deep venous thrombosis of the extremity,DVT)形成的情况。方法:回顾性分析2008年3月至2009年2月54例(男23例,女31例;年龄23～95岁)下肢闭合骨折术前经彩色多普勒超声(CDFI)确诊并发DVT患者...目的:探讨下肢闭合骨折术前并发深静脉血栓(deep venous thrombosis of the extremity,DVT)形成的情况。方法:回顾性分析2008年3月至2009年2月54例(男23例,女31例;年龄23～95岁)下肢闭合骨折术前经彩色多普勒超声(CDFI)确诊并发DVT患者的临床资料,分析下肢骨折并发DVT的危险因素。结果:下肢DVT包括髂外静脉血栓、股静脉血栓、腘静脉血栓、胫后静脉血栓、比目鱼肌静脉血栓。下肢骨折术前并发DVT形成情况:①患者年龄70岁以上23例;②骨折合并其他病症11例,其中合并高血压2例,合并高血压和糖尿病3例,合并高血压和脑梗死2例,合并高血压、糖尿病和冠心病4例;③多发骨折10例;④下肢骨折后7～14d发生DVT28例。结论:DVT发生的危险因素包括:高龄,术前合并高血压、糖尿病、冠心病和脑梗死等疾病,下肢多发多段骨折。DVT多发生在下肢骨折后7～14d,尽早安排手术治疗比其他预防DVT措施在降低围术期肺栓塞风险中更有重要意义。展开更多
文摘Background: With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative D-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography. Objective: To evaluate and compare the safety of 2 diagnostic strategies for deep venous thrombosis. Design: Randomized, multicenter trial. Setting: Four university hospitals. Patients: 810 outpatients with suspected deep venous thrombosis and negative results on proximal vein ultrasonography. Interventions: Erythrocyte agglutination D-dimer testing followed by no further testing if the result was negative and venography if the result was positive(experimental) or ultrasonography repeated after 1 week in all patients(control). Measurements: Symptomatic deep venous thrombosis diagnosed initially and symptomatic venous thromboembolism during 6 months of follow-up. Results: Nineteen of 408 patients(4.7%) in the D-dimer group and 3 of 402 patients(0.7%)in the repeated ultrasonography group initially received a diagnosis of deep venous thrombosis(P< 0.001). During follow-up of patients without a diagnosis of deep venous thrombosis on initial testing, 8 patients(2.1% 95%CI, 0.9%to 4.0% ) in the D-dimer group and 5 patients(1.3% CI, 0.4%to 2.9% ) in the repeated ultrasonography group developed symptomatic venous thromboembolism(difference, 0.8 percentage point CI,-1.1 to 2.9 percentage points ; P >0.2). Venous thromboembolism occurred in 1.0%(CI, 0.2%to 2.8%) of those with a negative D-dimer result. Limitations: Seventy patients(8.6%) deviated from the diagnostic protocols, and 9 patients(1.1%) had inadequate follow-up. Conclusion: In outpatients with suspected deep venous thrombosis who initially had normal results on ultrasonography of the proximal veins, a strategy based on D-dimer testing followed by no further testing if the result was negative and venography if the result was positive had acceptable safety and did not differ from the safety of a strategy based on withholding anticoagulant therapy and routinely repeating ultrasonography after 1 week.
文摘目的:探讨下肢闭合骨折术前并发深静脉血栓(deep venous thrombosis of the extremity,DVT)形成的情况。方法:回顾性分析2008年3月至2009年2月54例(男23例,女31例;年龄23～95岁)下肢闭合骨折术前经彩色多普勒超声(CDFI)确诊并发DVT患者的临床资料,分析下肢骨折并发DVT的危险因素。结果:下肢DVT包括髂外静脉血栓、股静脉血栓、腘静脉血栓、胫后静脉血栓、比目鱼肌静脉血栓。下肢骨折术前并发DVT形成情况:①患者年龄70岁以上23例;②骨折合并其他病症11例,其中合并高血压2例,合并高血压和糖尿病3例,合并高血压和脑梗死2例,合并高血压、糖尿病和冠心病4例;③多发骨折10例;④下肢骨折后7～14d发生DVT28例。结论:DVT发生的危险因素包括:高龄,术前合并高血压、糖尿病、冠心病和脑梗死等疾病,下肢多发多段骨折。DVT多发生在下肢骨折后7～14d,尽早安排手术治疗比其他预防DVT措施在降低围术期肺栓塞风险中更有重要意义。
